bsn iii 5 c 4 corneal laceration john kelvin malabanan

CORNEAL LACERATIONCORNEAL LACERATION

PREPARED BY: JOHN KELVIN R. MALABANAN

BSN III-5

PREPARED BY: JOHN KELVIN R. MALABANAN

BSN III-5

Lyceum of The Philipines University BatangasCapitol Site, Batangas City

I. INTRODUCTIONI. INTRODUCTION

Corneal laceration is common ocular injuries in with epithelial cells are lost. Laceration can be caused by scratches from objects of a foreign body, or over worn contact lenses. The patient presents with sudden onset of pain, which is often intense, photophobia, foreign body such as a mascara brush, twig or fingernail. They also may be a result sensation, and tearing. Visual acuity may be normal or decreased depending on the site of the lesion.

Corneal laceration is common ocular injuries in with epithelial cells are lost. Laceration can be caused by scratches from objects of a foreign body, or over worn contact lenses. The patient presents with sudden onset of pain, which is often intense, photophobia, foreign body such as a mascara brush, twig or fingernail. They also may be a result sensation, and tearing. Visual acuity may be normal or decreased depending on the site of the lesion.

Mortality from corneal lacerations is rare. However, morbidity from corneal lacerations is significant. Corneal lacerations or

subsequent secondary infection (endophthalmitis) can result in complete or partial loss of vision, loss of the eye, or systemic infection.

In this case study, we eagerly enough to know and understand better the corneal laceration. It is better for us to be educated because it is common among the children as well as the prevention and

management whenever corneal laceration occur.

Mortality from corneal lacerations is rare. However, morbidity from corneal lacerations is significant. Corneal lacerations or

subsequent secondary infection (endophthalmitis) can result in complete or partial loss of vision, loss of the eye, or systemic infection.

In this case study, we eagerly enough to know and understand better the corneal laceration. It is better for us to be educated because it is common among the children as well as the prevention and

management whenever corneal laceration occur.

II. OBJECTIVESII. OBJECTIVES

General Objectives

This study aims that the nursing student will be able to enhance and gain knowledge as well as the skills and attitude through effective utilization of nursing process and appropriate nursing action including the effect to every individual, its manifestation and prevention and necessary treatment of patient with corneal laceration.

General Objectives

This study aims that the nursing student will be able to enhance and gain knowledge as well as the skills and attitude through effective utilization of nursing process and appropriate nursing action including the effect to every individual, its manifestation and prevention and necessary treatment of patient with corneal laceration.

Specific Objective

At the end of the study, the nurse will be able to:

Specific Objective

At the end of the study, the nurse will be able to:

1. State the patient profile, past health history, family history, personal and social health history, psychologic history as well as history of present illness.

2. Assess the body parts of the patient to identify the condition and abnormalities of each part.

3. Analyze and interpret the laboratory exam of the patient to know the condition related to disease.

4. Understand the anatomical parts and functions of the affected part of the disease.

1. State the patient profile, past health history, family history, personal and social health history, psychologic history as well as history of present illness.

2. Assess the body parts of the patient to identify the condition and abnormalities of each part.

3. Analyze and interpret the laboratory exam of the patient to know the condition related to disease.

4. Understand the anatomical parts and functions of the affected part of the disease.

5. Explain and identify the cause, the disease process and its manifestation.

6. Utilize the nursing process in rendering care based on the patient’s needs and concerns

7. Enumerate and discuss the drugs that have been administered to manage the patient’s condition.

8. Lastly, state a prognosis to the patient.

5. Explain and identify the cause, the disease process and its manifestation.

6. Utilize the nursing process in rendering care based on the patient’s needs and concerns

7. Enumerate and discuss the drugs that have been administered to manage the patient’s condition.

8. Lastly, state a prognosis to the patient.

III. PATIENT PROFILEIII. PATIENT PROFILENAME: Child XAGE: 8 yrs. oldSEX: MaleDATE OF BIRTH: May 1, 2001CIVIL STATUS: Single ADDRESS:Bagong Pook San Vicente Lipa CityNATIONALITY: FilipinoRELIGION: Roman CatholicDATE OF ADMISSION: Dec 4, 2008ATTENDING PHYSICIAN: Dr. AllegreCHIEF COMPLAIN: Corneal Laceration ODADMITTING DIAGNOSIS: Corneal Laceration OD

NAME: Child XAGE: 8 yrs. oldSEX: MaleDATE OF BIRTH: May 1, 2001CIVIL STATUS: Single ADDRESS:Bagong Pook San Vicente Lipa CityNATIONALITY: FilipinoRELIGION: Roman CatholicDATE OF ADMISSION: Dec 4, 2008ATTENDING PHYSICIAN: Dr. AllegreCHIEF COMPLAIN: Corneal Laceration ODADMITTING DIAGNOSIS: Corneal Laceration OD

IV. CLINICAL APPRAISALIV. CLINICAL APPRAISAL

A. PAST HEALTH HISTORYAccording to Mrs. Z child X

mother, that child z is completed to her childhood immunization. She has no allergies to any drugs. Child X doesn’t have any injury or accident in the past. And it is the first time that child X was confined in the hospital.

B. FAMILY HISTORYMrs. Z is 28 yrs. old and child X

father is 29 yrs. old. Chills X grandmother is 56 yrs, old and her grand father is 58 yrs. old parents of Mrs. Z.

A. PAST HEALTH HISTORYAccording to Mrs. Z child X

mother, that child z is completed to her childhood immunization. She has no allergies to any drugs. Child X doesn’t have any injury or accident in the past. And it is the first time that child X was confined in the hospital.

B. FAMILY HISTORYMrs. Z is 28 yrs. old and child X

father is 29 yrs. old. Chills X grandmother is 56 yrs, old and her grand father is 58 yrs. old parents of Mrs. Z.

PERSONAL HISTORYChild X is a playful child. He is sleeping

more than 8 hours. According to Mrs.Z child X is like to play most of the time. And she has no any diet. She likes to eat sweet foods. Childs X eat what he wants.

SOCIAL HISTORYChild X is living in a safe and peaceful place.

There are no any problems to their area. Child X is able to mingle or socialize with their neighbour especially to her playmates.

PSYCHOLOGICAL HISTORY

The major stressor of child X is when Mrs. Z preparing her to getting to sleep. There is no specific psychological problem does Child X have.

HISTORY OF PRESENT ILLNESS

Dec 2, 2008 when the accident happened. Child X and her brother was playing that time and accidentally that the spine of the flower comes into his eyes. at that time Mrs. Z is working.. Mrs. Z observed that the right eye of child X has injury. She tests if the right eye has a vision by covering the left eye but the right eye doesn’t react. After that they go to EENT but it’s already closed. Dec 4, 2008 when child Z is admitted in the BRH. According to Mrs. Z child X felt pain that time and she was crying. Child Z was diagnosed having corneal laceration.

V. PHYSICAL ASSESSMENTV. PHYSICAL ASSESSMENTAREA

ASSESED METHOD FINDING ANALYSIS

Skin >Inspection -Smooth, soft and flexible.

-Moisture varies with activity, body and environmental temperature humidity and skin folds and the axillae.

-Normal. It is the normal texture of the skin of the children.-Normal.

AREA ASSESED

METHOD FINDING ANALYSIS

Hair

Nails

>Palpation

>Inspection>Palpation

>Inspection

-Temperature of the skin is warmth.

-Absence of redness or scallyness in the scalp.

-Thin and very short with normal hair distribution.

-Absence of lice.

-Pink color of fingernails.

-Normal

-Normal

-Normal

-Normal

-Normal.

AREA ASSESED


Head

Eyes:eye brow

:Eye lashes:Conjunctiva

:Cornea

>Inspection

>Inspection

>Inspection>Inspection

>Inspection

-Absence of abrasion.-Absence of seborrhea.-Symmetrical.

-Symmetrically aligned.-With normal hair distribution.-Equal movement. -Normal distribution.-Pink and moist palpebral conjunctiva.-Presence of scratch in the epithelium.

-Normal-Normal-Normal

-Normal-Normal


-Abnormal. Scratch is due to the

AREA ASSESED


Head

Eyes:eye brow

:Eye lashes:Conjunctiva

:Cornea

>Inspection

>Inspection


>Inspection

-Absence of abrasion.-Absence of seborrhea.-Symmetrical.

-Symmetrically aligned.-With normal hair distribution.-Equal movement. -Normal distribution.-Pink and moist palpebral conjunctiva.-Presence of scratch in the epithelium.


-Normal-Normal


-Abnormal. Scratch is due to the

AREA ASSESED


:Pupillary reaction

Ear



-No vision (right eye).-Not constricting and not dilating (right eye).

-Symmetrically aligned.-Firm, smooth, free from lesion and pain.

effect of accidentally poking the eye with nail cutter.-Abnormal. Blindness caused bycorneal laceration.-Normal.-Normal.

AREA ASSESED


Nose

Mouth:Lips

:Teeth

: Tongue:Gums

>Inspection

>Inspection

>Inspection


-Symmetrical.-Midline of the face without swelling, lesion and masses.

-Pink, firm moist without lesion and inflammation.

-Properly aligned and shiny, presence of 6 teeth.-Tongue at the midline.-Gums are pink, moist, smooth and firm.

-Normal.-Normal.

-Normal. It is normal hydration of lips of children.-Normal.

-Normal-Normal.

AREA ASSESED


:Tonsil

Neck

Chest and Lungs

>Inspection


>Inspection

-Tonsils are present.-No enlargement of thyroid gland.-Lymph node is not palpable.

-Respiration rate of 21 breaths per minute.-Thorax rises and fall.

-Normal.

-Normal-Normal. Palpable nodes may result from variety of disease.-Normal. 15-25 bpm is the normal RR of 3 yrs. old.-Normal

AREA ASSESED


Heart

Abdomen

Upper and lower extremities

>Auscultation

>Inspection

>Palpation


-87 breaths per minute.

-Rounded and bilaterally symmetrical.-Tenderness and warmth skin temperature.-No edema.-Strong muscle strength.

.

-Normal. 75-100 breaths per minute is the cardiac rate of 3 yrs. old.

-Normal.

-Normal.

-Normal.-Normal.

AREA ASSESED


Genitalia >Inspection -Absence of swelling.-Absence of discharges

-Normal.-Normal

SUMMARY OF PHYSICAL ASSESSMENT

Child Z the subject of the study is diagnosed with corneal laceration. Physical appearance of the patient was assessed through inspection, palpation, percussion and auscultation. This will serve as a baseline guide to recognized the sign and symptoms of the disease.

as I assessed child Z’s for General survey I noted no vision (blind) on her right eye because of her corneal laceration that affect her vision.

VI.DIAGNOSTIC AND LAB RESULT

VI.DIAGNOSTIC AND LAB RESULTTEST

EXAMINATION RESULT NORMAL

VALUE ANALYSIS

WBC

RBC

13.50

4.5

0.38-0.47

4.2-5.4

Abnormal. Elevated WBC count indicates stress such as long lasting emotional upset.Normal.

TEST EXAMINATION

RESULT NORMAL VALUE

ANALYSIS

HEMOGLOBIN

HEMATOCRIT

116.5

0.39

120-140

0.38-0.47

Abnormal. Decrease hemoglobin level indicates anemia but usually the client is not considered anemia until the level is less than 10.5/dl.

Normal.

TEST EXAMINATION

RESULT NORMAL VALUE

ANALYSIS

MCH

MCV

RDWPLATELET

25.86

81

12427

27-31

80-96

11.5-14.5150-400

Abnormal. Decrease in the MCH indicates microcytic anemia.Normal.

Normal.Abnormal. Elevated platelet indicates trauma such as injury.

VII. ANATOMY AND PHYSIOLOGY

VII. ANATOMY AND PHYSIOLOGYCORNEA- A transparent, avascular, domelike structure, forms the

most anterior portion of the eyeball and is the main refractingsurface of the eye. It is composed of five layers: epithelium,bowman’s membrane, stoma, descemet’s membrane andendothelium. Cornea is the anterior sixth of the eye that permitslight to enter the eye. As part of the focusing system the fibroustunic, it also bends, or refracts, the entering light. The blood supply to the cornea is derived from the limbal vessels, thenutritional elements passing through the avascular cornea fromthe limbus, although some oxygen is derived from the fifth cranialnerve. The superficial corneal layers contain about 70 sensorynerve fibers,which accounts for the severe pain that result fromseemingly minor irritative phenomena.

CORNEA- A transparent, avascular, domelike structure, forms themost anterior portion of the eyeball and is the main refractingsurface of the eye. It is composed of five layers: epithelium,bowman’s membrane, stoma, descemet’s membrane andendothelium. Cornea is the anterior sixth of the eye that permitslight to enter the eye. As part of the focusing system the fibroustunic, it also bends, or refracts, the entering light. The blood supply to the cornea is derived from the limbal vessels, thenutritional elements passing through the avascular cornea fromthe limbus, although some oxygen is derived from the fifth cranialnerve. The superficial corneal layers contain about 70 sensorynerve fibers,which accounts for the severe pain that result fromseemingly minor irritative phenomena.

EPITHELIAL CELL- has 5-6 layers, Are capable of rapidreplication and completely replaced every 7 days.

BOWMANS MEMBRANE- The second layer moving in toward theeye, serves as the smooth adhesion layer for the basementmembrane of the epithelial cells. A clear accellular layer which is amodified portion of thev superficial stroma.This layer is notcrucial for clarity or visual function since removal ofthe Bowman layer during photorefractive keratectomydoes not negatively affect vision.

ENDOTHILEUM CELL- The innermost layer of the cornea is theendothelial cell layer, a monolayer of polarized cells. They are Arranged with their apical portion toward the aqueous humor inthe.anterior chamber. The endothelial cells are responsible formaintaining the desiccation of the stroma by actively removingwater.

DESCEMET’S MEMBRANE- Is the specialized basementmembrane of the endothelial cells positioned between the stromaand the endothelial cell layer. Any condition that causesinflammation of the cornea or the anterior chambercan cause Descemet membrane folds.

CORNEAL STROMAL- Consist of lamellas and accounts forabout 90% of the corneal thickness. Each lamellar fiber is istransparent , 1um thick and 15 um wide, and as long as thediameter of the cornea.The stromal lamellas are parallel to thecorneal surface but do interwine Each contain a flattened cellnucleus.Anterior chamber- Filled with a continually replenishedsupply of clearAqueous humor, which nourishes the cornea.

AQUEOUS HUMOR- Is produced by the ciliary body, and itsproduction is relat to the intraocular pressure 9IOD). Normal IOP is 10-20mmHg.

CORNEACORNEAL LACERATION

VIII. PATHOPHYSIOLOGYVIII. PATHOPHYSIOLOGY

Modifiable Non Modifiable

Caused of metallic object Impacting with sufficient force

Hazrdous Environment Age

Direct trauma to the cornea

Sign and SymptomsOcular trauma, pain, photophobic, anterior chamber

is shallow, bubbles with thin anterior chamber reduce with visual acuity.

Corneal Laceration

SUMMARY OF PATHOPHYSIOLOGY

A corneal laceration results from direct trauma to the cornea, typically from metallic object impacting with sufficient force, there may be either a full thickness laceration or a partial thickness laceration. A full thickness is termed a penetrating injury. In full thickness laceration there will be a flat chamber. Seidel’s sign will be present; as fluorescein is added, you will see the aqeous oozing out from the wound amidst the fluorescein there may alsobe bubbles in the anterior chamber. Damage to the iris may result in an irregular shaped, unreactive iris. Additional pressure on the globe may result in extrusion of uveal tissue through the wound.

IX. NURSING CARE PLANIX. NURSING CARE PLANASSESSMENT NURSING

DIAGNOSIS SCIENTIFIC

EXPLANATION PLANNING

O> The patient undergone corneal repair.

Risk for infection related to post operative incision.

Unlike most tissues in the body, the cornea contains no blood vessels to nourish or protect it against inspection. .(General Ophthalmology, 8th edition, D. Vaughan, T. asburg.)

After the 2 hours of nursing intervention the client’s risk for infection will be lessened.

INTERVENTION RATIONALE EVALUATION

> Wash hands with antibacterial soap before/ after each care activity.

>Reduces risk of cross contamination because gloves may have unnoticeable defects, get torn or damaged during use. Some pathogens may survive on hands for 31 hr. after exposure. Note: methicillin- resistant staphylococcus aureus (MRSA) is most commonly transmitted via direct contact with health care workers who fail to wash hands between patient contacts.(Nursing Care Plan 6th edition, Marilyn E. Doenges et.

al; pg.634)

The client’s risk for infection lessened.


> Inspect wounds/ site of invasive devices daily, paying particular attention to parenteral nutrition lines. Document sign of local inflammation/ infection changes in character of wound drainage.

> Investigate reports of pain out of proposition to visible signs.

>May provide clue to portal of entry, type of primary infecting organism as well as early identification of secondary infection. Note: high nutrition (TPN) provides excellent medium for bacterial growth. (Nursing Care

Plan 6th edition, Marilyn E. Doenges et. al; pg.634)

>Pressure like pain over area of cellulitis may indicate development of necrotizing fascutis due to group Abeta-hemplytic streptococci (GABS), necessiating prompt intervention. (Nursing Care Plan 6th edition, Marilyn E. Doenges et.

al; pg.634)


>Maintain sterile technique when changing dressings.

> Wear gloves/ gowns when changing caring for open wounds/ anticipating direct contact with secretions or excretions

>Prevents introduction of bacteria reducing risk of nasocomial infection. (Nursing Care Plan 6th edition, Marilyn E. Doenges

et. al; pg.634)

> Prevents spread of infection/ cross – contamination. (Nursing Care Plan 6th edition, Marilyn E. Doenges et. al; pg.634)


>Dispose of soiled dressing/ material in double bag.

>Assest with prepare for incision and drainage of wound, irrigation, application of warm/ moist in soaks, as indicated

> Reduces contamination/ soiled of area; limit spread of airborn organism.

> Facilitates removal of patient material / necrotic tissue healing and promotes healing. (Nursing Care Plan 6th edition,

Marilyn E. Doenges et. al; pg.634)

ASSESSMENT NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

PLANNING

S> “Madalas ang mata niya kapag pinapatakan ng gamot” as verbalized by the mother.O>restless>irritable>kept eyes closed.>guarding behaviour>scale 8/10

Acute pain related to tissue trauma secondary to post operative procedure.

Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage. .(General Ophthalmology, 8th edition, D.

Vaughan, T. asburg.pg86)

After the 2 hours of nursing intervention the client’s pain will be lessened to a tolerable level.


>Vital sign taken and recorded.

>Asked other who know client well.

>Provide information about the effectiveness of care.(Delmanr’s Pediatric Nursing Care Plans, 3rd edition, Luxner)

> To identify behaviour that may indicate pain when client is unable to verbalize.(Nurse’s Pocket Guide, 11th edition, Marilynn E. Doenges, pg 500)

The client’s pain decreased to a tolerable level.

INTERVENTION RATIONALE EVALUATION .>Provide comfort measure, quite environment and calm activities.

>Obtained client’s assessment of pain to include location, characteristics, onset/duration, frequency, quality intensity and precipitating/aggravating factors. Reassaa each time pain occurs/ is

>To promote nonpharmacological pain management.(Nurse’s Pocket Guide,

11th edition, Marilynn E. Doenges, pg 501)

>To rule out worsening of underlying condition/ development of complication. (Nurse’s Pocket Guide, 11th edition, Marilynn E. Doenges, pg 500)

INTERVENTION RATIONALE EVALUATION reperted. Note and investigate changes from previous report. >Observed non verbal cuts/ pain behaviours and other objective. Defining characteristics, as noted especially in person who cannot communicate verbally.

>Note when pain occurs.

>Observation may/ may not be congruent with verbal reports or may be only indicator present when client is unable to verbalize.(Nurse’s Pocket Guide, 11th edition, Marilynn E. Doenges, pg 500)

>To medicate prophylactically, as appropriate.(Nurse’s Pocket Guide, 11th edition, Marilynn E. Doenges, pg

501)

INTERVENTION RATIONALE EVALUATION >Advised the mother to provide diversional activities by giving toys.

>Administered analgesics, as indicated, to maximum dosage as needed.

>Evaluate/document client’s response to analgesic and assist in transitioning/altering drug regimen based on individual needs.

>To distract attention andreduce tension.(Nurse’s Pocket Guide,

11th edition, Marilynn E. Doenges, pg 501)

>To maintain “acceptable” level of pain. Notify physician if regimen is inadequate to pain control goal.(Nurse’s Pocket Guide, 11th edition, Marilynn E. Doenges, pg 502)

>Increasing/ decreasing dosage, stepped program helps in self management of pain.(Nurse’s Pocket Guide, 11th edition, Marilynn E. Doenges, pg 502)

ASSESSMENT NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

PLANNING

S>Madalas ay umiiyak ang aking anak marahil dahil hindi sya komportable ditto sa hospital”as verbalized by the mother.O>crying>upset>irritable>difficulty in sleeping

Anxiety related to unfamiliar environment.

An emotional state characterized by feeling of apprehension, discomfort, restlessness, or worry. (Medical–surgical nursing,vol.1,11th edition,Smeltzer, pg.112)

After the shift the client will be able to adapt in the hospital.


>Advised the motherto provide divertional activitiesby giving toys.

>Determined the client’s sleep and activity pattern.Monitor vital signsReview coping skillsused in past.

>To distract attention and reduce tension.(Nurse’s Pocket Guide, 11th edition, Marilynn E. Doenges, pg 501)

>To determined those that might be helpful in current circumstances. (Nurse’s Pocket Guide, 11th edition, Marilynn E. Doenges, pg 91)

The client was able to adapt to the hospital as evidenced by verbalization of:“Hindi na umiiyak ang aking anak,maaliwalas na ang kanyang mukha at komportable na sa hospital.


>Review symptoms to be reported to physician e.g., increase in frequency/ duration of attacks, change in response medication.

> Knowledge of expectations can avoid undue concern for insignificant reasons or delay in treatment of important symptoms .(Nurse’s Pocket Guide, 11th

edition, Marilynn E. Doenges, pg 502)

X. DRUG STUDYX. DRUG STUDY NAME OF DRUG

CLASSIFICATION AND MECHANISM

OF ACTION

INDICATION ADVERSE REACTION

GENERIC NAME:

Ketorolac tromethamine

DOSAGE:8mg

Opthalmic anti-inflammatory.

Thought to inhibit the action of cyclooxygenase, an enzyme

>Relief from ocular itching caused by seasonal allergic conjunctivitis

>Post-operative inflammation in patients who

>CNS: Headache.EENT: Transient stinging and burning on neal edema, corneal infiltrates, iritis, ocular

NAME OF DRUG


OF ACTION


ROUTE:IV

FREQUENCY:Q1

responsibility for prostaglandin synthesis. Prostaglandins medicate the inflammatory response and also cause miosis.

have had cataract extraction.

>Reduce ocular pain, burning and stinging after corneal refractive surgery.

, superficial ocular infections. edema and ocular inflammation, ocular irritation, ocular pain, superficial keratitis, superficial ocular infections.

CONTRAINDICATION NURSING RESPONSIBILITY

MONITORING PARAMETERS

>Contraindicated in patients hypersensitive to components of drug and in those wearing soft contact lenses.

>Store drug away from heat in a dark, tightly closed container and protect from freezing.

>May increase ALT and AST levels. >May increase bleeding time.

NAME OF DRUG CLASSIFICATION AND

MECHANISM OF ACTION


GENERIC NAME:Paracetamol

DOSAGE:220mg

ROUTE:Oral

FREQUENCY:Q4

Nonopioid analgesic and antipyretics.

Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin

> Mild pain. HEMATOLOGIC: Hemolytic anemia, leukopenia, neutropenia, pancytopenia.HEPATIC: jaundiceMETABOLIC: HypoglycemiaSKIN: Rash uticaria.

NAME OF DRUG

CLASSIFICATION AND MECHANISM OF ACTION


in the CNS or of other substance that sensitize pain receptors to stimulation . The drug may relieve fever through central action in the hypothalamic heat regulating center.



>contraindicated in patient hypersensitive to drug.

>ALERT: Many OTC and prescription products contain acetaminophen: be aware of this when calculating total daily dose.

>Use liquid form for children and patients who have difficulty

>May decrease glucose and haemoglobin levels and hematocrit.

>May decrease neutrophil WBC< RBC and platelets counts.

>May cause false positive test result for urinary 5+hydrocyindoleatic acid.



swallowing.>In children don’t exceed five doses in 24 hrs.

glucose level inhome monitoring system

>May falsely decrease glucose level in home monitoring system

NAME OF DRUG

CLASSIFICATION AND

MECHANISM OF ACTION


GENERIC NAME:Oxytetracycline

DOSAGE:1 drop

ROUTE:Eye

FREQUENCY:Q2

Tetracycline

Tetracycline are bacteriostatic but maybe bactericidal against certain organisms. They find reversibly

> used to treat infections of the respiratory and urinary tracts, skin, ear, eye and Gonorrhoea

DENTAL: Discolorin and inadequate calcification of primary teeth of fetus if used by pregnant women, discolouring and inadequate calcification of permanent teeth if used

NAME OF DRUG


OF ACTION


30s and 50s ribosomal subunits, which inhibits bacterial protein synthesis.

during dentaldevelopment.DERMATOLOGIPhotoxic reaction, rash, exfoliative dermatitis.GI: Fatty liver failure, anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis,

NAME OF DRUG


OF ACTION


GENERIC NAME:Gatifloxacin

DOSAGE:1 drop

ROUTE:Eye

Frequency:Q2

Ophthalmic anti-infectives.

Inhibits DNA gyrase and topoisomerase, preventing cell replication and division.

>External ocular infection caused by suspectible organisms.

CNS: Headache.EENT: Conjunctival irritation, increased lacremation, keratitis, papillary conjunctivitis, chemosis, conjunctivalHemorrhage, discharge, dry eyes, eye irritation, eyelid edema, pain, red eyes, reduced visual acuity.

GI: Taste disturbance

CONTRAINDICATION

NURSING RESPONSIBILITY MONITORING PARAMETERS

>Contraindicated in patient by hypersensitive to drug or other quinolones.

>Don’t injectsolution subconjunctivally orinto the anteriorchamber of theEye.

>Systemic drug may cause serious hypersensitivity reaction. If allergic reaction occur, stop and treat symptoms.

>Monitor patient for super infection.

>May increase ALT,AST and LDH levels.

NAME OF DRUG


OF ACTION


GENERIC NAME:

TrobromycinDOSAGE:

7 drops

ROUTE:Eyes

FREQUENCY:Q4

Ophthalmic anti-inflammatory.

Thought to inhibit protein synthesis, usually bactericidal.

>External ocular injection by susceptible bacteria.

EENT: blured vision with ointment burning or stinging on instillation, conjunctival erythema, increased lacremation, lid itching or swelling.



>Contraindicated in patients hypersensitive to drug or other amino glycosides.

>When two different ophthalmic solution are used, allow at least minutes between instillations.

>Alert: Tobromycin ophthalmic solution isn’t for injection.

None reported.



>If topical ocular tobramycin in is given with systemic tobramycin, carefully monitor level.

>Prolonged used may result in overgrowth of non susceptible organisms including fungi.

XI. PROGNOSISXI. PROGNOSIS

Prognosis is good. Patient become stabilize. The lab result return to normal values. She gain normal strength. She was discharge last December 13, 2008.

Prognosis is good. Patient become stabilize. The lab result return to normal values. She gain normal strength. She was discharge last December 13, 2008.

XII. DISCHARGE PLANNINGXII. DISCHARGE PLANNING

M- Advised to continue regular intake of medication prescribed by the physician

E- Such as multi vit.-500ml OD instructed the patient the modification of home environment to facilitate the challenge of living with an illness.

T- Reminded the mother of patient to give the medication the right time.

H- Advised the mother of patient to assist in maintaining personal hygiene and emphasize the importance of good hygiene such as bathing, mouth care and many hygienic practices.

M- Advised to continue regular intake of medication prescribed by the physician

E- Such as multi vit.-500ml OD instructed the patient the modification of home environment to facilitate the challenge of living with an illness.

T- Reminded the mother of patient to give the medication the right time.

H- Advised the mother of patient to assist in maintaining personal hygiene and emphasize the importance of good hygiene such as bathing, mouth care and many hygienic practices.

O- Instructed the mother of patient to have a follow up check up after a months.

D- Instructed the relatives to provide nutritious

food.

S- Emphasized to the family members the importance of having a positive attitude and continuing support to keep the recovery of the patient by giving positive reinforcement to the progress made by the patient provided spiritually guidance through giving the patient opportunities to experience prayer.

ACKNOWLEDGEMENTACKNOWLEDGEMENTFirst of all I want to thank almighty God who is always there to support and guide in our daily living.

To my family who always at my side and support me in all my problems.

To Batangas Regional Hospital who trust us and permitted me to handled my patient.

To Dra.Iturralde our clinical instructor who guide us in rendering care to our patient and being approachable when we need them.

First of all I want to thank almighty God who is always there to support and guide in our daily living.

To my family who always at my side and support me in all my problems.

To Batangas Regional Hospital who trust us and permitted me to handled my patient.

To Dra.Iturralde our clinical instructor who guide us in rendering care to our patient and being approachable when we need them.

Also to my group mates who always there to make our duty enjoyable, when I need an accompany and answer all my calls.

THANK YOU. . .

BIBLIOGRAPHYBIBLIOGRAPHYMedical –surgical nursing, vol.1, 11th edition, Smeltzer.

General Ophthalmology, 8th edition, D. Vaughan, T.asburg.

Laboratory and Diagnostic tests with nursing implecations 7th edition, Joyce Lefever kee.

Essentials of Anatomy and Physiology, 6th edition, Seeley Stephens.

Nursing Care Plan 6th edition, Marilyn E. Doenges et. al;

Medical –surgical nursing, vol.1, 11th edition, Smeltzer.

General Ophthalmology, 8th edition, D. Vaughan, T.asburg.

Laboratory and Diagnostic tests with nursing implecations 7th edition, Joyce Lefever kee.

Essentials of Anatomy and Physiology, 6th edition, Seeley Stephens.

Nursing Care Plan 6th edition, Marilyn E. Doenges et. al;

Spring House Nurse’s Drug Guide 2007, Samantha Venable RN, MS, FNP.

Nursing 2008 Drug handbook, 28th edition, Wolters kluwer et, al;

bsn iii 5 c 4 corneal laceration john kelvin malabanan

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